logic is also very sound . I also like the simplicity of the idea as it ’ s very easy to understand and share . It ’ s a tremendous training tool as you are able to show all of the ways in which infection can happen and this abstraction can be applied to a number of different practical examples . Where it falls down is in its extension from a tool of analysis and training , into a paradigm for action : it ’ s simply not workable in some settings at some times and the culture around handwashing is such that we can ’ t even talk about this without fear of reproach .”
The paper , authored by McKnight with fellow experts Dinah Gould , Edward Purssell , Annette Jeanes , Nicolas Drey , and Jane Chudleigh , was driven by their unique experiences , says
The Five Moments predate contemporary guideline development .
Newer approaches emphasize the importance of balancing benefits and harms , patient values and preferences , acceptability and equity , as well as feasibility and strength of the evidence in line with the WHO recommendations .”
McKnight .
“ Professor Dinah Gould is a font of all things hand hygiene and I ’ ve never known a researcher who knows their field better ,” he says . “ As such , she could see both the positives and the negatives of the approach and was an excellent person to be able to provide evidence for both . By contrast , I ’ m a health systems researcher and am more interested in how medical work gets done and have a lot of sympathy for stressed clinicians having previously focused on the gap between high-minded guidelines and the realities of night shifts . I ’ m also an inventor ( of a hygienic door handle ) and so was always interested in alternative , design-based solutions to problems that make doing the right thing the easiest thing .”
The first inconvenient truth , according to the researchers , is that the Five Moments framework was conceptualized without including the perspectives of stakeholders . New thought around how to boost compliance with infection prevention-related practices is to cultivate opportunities for ownership of policies and procedures by healthcare personnel and the chance to have a greater say in how a hospital achieves consensus on those P & Ps .
As Gould and Purssell , et al . ( 2022 ) acknowledge , “ The Five Moments predate contemporary guideline development . Newer approaches emphasize the importance of balancing benefits and harms , patient values and preferences , acceptability and equity , as well as feasibility and strength of the evidence in line with the WHO recommendations . The Five Moments … do not consider the perspectives of health workers , although adherence increases if their views are considered .”
McKnight acknowledges that despite healthcare professionals ’ views not being incorporated into the aging WHO guidance , there exists a continued loyalty toward it among members of the healthcare community .
“ As with other areas of medicine and other types of practice , culture and identity seem important ,” he says . “ I think the prevailing shared identity of infection control leaders is one of control , rigor , surveillance , and adherence . Think about those words and the metaphors they imply . Hand sanitization is something that is enforced and health workers either adhere
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gap in knowledge is the precise minimum inoculum necessary for skin-to-skin transmission has not been determined and could help inform the efficacy of both alcohol-based handrub formulations and handrub technique , the experts said .
As the taskforce confirmed , “ Currently , there is no established consensus in the literature regarding the ideal technique , volume , or duration of hand hygiene . Ideally , an optimal hand hygiene action would prevent the transmission of pathogens through the hands of healthcare workers . However , defining this concept is challenging because of varying levels of hand contamination among healthcare workers and the minimum inoculum required for transmission . The level of hand contamination among healthcare workers depends on clinical activity , and the minimum inoculum for transmission may vary among different pathogens and bacteria . “
The taskforce pointed to a study conducted in a laboratory setting using Escherichia coli ( E . coli ) which demonstrated that only a 1 log10 minimum inoculum was required for transmission and add , “ As hand contamination in clinical care rarely exceeds 3 log10 , it is hypothesized that a 2 log10 reduction , achieved through hand hygiene , is sufficient to prevent transmission .”
If there ’ s no true consensus on which technique is superior , there is also a question around the volume of hand
Currently , there is no established consensus in the literature regarding the ideal technique , volume , or duration of hand hygiene .”
hygiene product that is presumed to be effective at killing microorganisms . One of the widely accepted parameters is using 1.1 mL per application of alcohol-based handrub product for effective hand disinfection , as recommended by WHO and embraced by many manufacturers .
Kampf and Ruselack , et al . ( 2013 ) aimed to determine hand coverage for three handrubs ( two gels based on 70 percent v / v and 85 percent w / w ethanol and a foam based on 70 percent v / v ethanol ) applied at various volumes . The researchers tested product volumes of 1.1 mL , 2 mL , 2.4 mL as well as 1- and 2-pump dispenser pushes ; the foam product was tested in addition at foam volumes of 1.1 mL , 2 mL , and 2.4 mL . Products were supplemented with a fluorescent dye and 15 participants applied products using responsible application techniques without any specific steps but the aim of completely covering both hands . Coverage quality was determined under ultraviolet light by two blinded investigators . For each experiment , the hands of 12 participants were contaminated with Serratia marcescens and the products applied as recommended ( 1.1 mL for 70 percent v / v ethanol products ; 2 mL for the 85 percent w / w ethanol product ). Log10-reduction was calculated .
The researchers found that volumes less than 2 mL yielded high rates of incomplete coverage ( 67 percent to 87 percent ) whereas volumes more than 2 mL gave lower rates ( 13 percent to 53 percent ). Differences in coverage were significant between the five volumes tested for all handrubs but not between the three handrubs themselves . Application of 1.1 mL of 70 percent v / v ethanol rubs reduced contamination by 1.85 log10 or 1.60 log10 ( ASTM E 1174-06 ); this failed FDA efficacy requirement of at least 2 log10 . Application of 2 mL of the 85 percent w / w ethanol rub reduced contamination by 2.06 log10 ( ASTM E 1174-06 ), fulfilling the FDA efficacy requirement . Similar results were obtained according to ASTM E 2755-10 .
Kampf and Ruselack , et al . ( 2013 ) emphasized that their data indicated that handrubs based on 70 percent ethanol
16 • www . healthcarehygienemagazine . com • may 2024